Provider Demographics
NPI:1225368111
Name:RODRIGUEZ, LUCY A (MD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 SANCTUARY CLUB RD
Mailing Address - Street 2:UNIT 109
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6645
Mailing Address - Country:US
Mailing Address - Phone:407-930-1112
Mailing Address - Fax:407-930-1114
Practice Address - Street 1:1111 S SEMORAN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1480
Practice Address - Country:US
Practice Address - Phone:407-930-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17805208D00000X
FLACN 762208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice